1
|
Hasser E, Peshkin BN, Hamilton JG, Brower J, Ovadia H, Ross LF, Sacca R, Tarini B, Domchek SM, Vittone S, Sleiman M, Isaacs C, Knerr S, Wilfond BS, Tercyak KP. Measuring high-risk parents' opinions about direct-to-consumer genetic testing for adult-onset inherited cancer syndromes in their adolescent and young adult children. J Genet Couns 2023; 32:768-777. [PMID: 36748334 PMCID: PMC10404634 DOI: 10.1002/jgc4.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
Neither direct-to-consumer (DTC) genetic testing nor predictive genetic testing for adult-onset conditions is recommended for minor children due to ethical concerns and low clinical utility. However, parents with pathogenic variants (PVs) in disease-causing genes may be interested in pursuing genetic testing that includes the familial PV for their children. The Pediatric Testing Attitudes Scale (P-TAS) was previously developed to examine high-risk parents' opinions about pediatric BRCA genetic testing for adult-onset breast/ovarian cancer. Here, the psychometric properties of the P-TAS were examined in a new sample of N = 126 parents (M age = 47.2 years) with PVs in a more complete set of cancer risk genes represented on DTC panel tests. The mean score on the P-TAS was 44 out of a maximum score of 60, indicating that a majority of parents generally held favorable opinions about testing their children for adult-onset inherited cancer syndromes. The internal consistency of the full scale was high (α = 0.91). A factor analysis identified two-component scales, labeled Attitudes and Beliefs (α = 0.93) and Decision Making and Communication (α = 0.83). In a multivariable regression model, P-TAS co-factors accounted for 34% of variance in parental opinions, including the frequency of prior family communication about cancer and the likelihood of utilizing DTC genetic testing with children (R2 = 0.34, p < 0.001). Results suggest that the P-TAS remains a reliable measure to assess high-risk parents' opinions about pediatric DTC genetic testing for adult-onset conditions, with promising validity. Applications of the P-TAS include informing genetic counseling practice, pediatric medical care, and policy guidelines surrounding DTC genetic testing.
Collapse
Affiliation(s)
- Emily Hasser
- University of Washington, Seattle, Washington, USA
| | - Beth N. Peshkin
- Georgetown University, Washington, District of Columbia, USA
| | | | - Jamie Brower
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hannah Ovadia
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Rosalba Sacca
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Beth Tarini
- Children's National Health System, Washington, District of Columbia, USA
| | | | - Sarah Vittone
- Georgetown University, Washington, District of Columbia, USA
| | - Marcelo Sleiman
- Georgetown University, Washington, District of Columbia, USA
| | - Claudine Isaacs
- Georgetown University, Washington, District of Columbia, USA
| | - Sarah Knerr
- University of Washington, Seattle, Washington, USA
| | | | | |
Collapse
|
2
|
Abman SH, Armstrong S, Baker S, Bogue CW, Carlo W, Chalak L, Daniels SR, Davis S, Debaun MR, Fike C, Frazer L, Gibson K, Gill M, Glass H, Gordon CM, Goyal M, Hirschhorn J, Holtz L, Hunstad DA, Leonard MB, Maitre N, Markham L, McAllister-Lucas L, Orange J, Shah P, Simon T, Steinhorn RH, Tarini B, Walker-Harding LR. The american pediatric society and society for pediatric research joint statement against racism and social injustice. Pediatr Res 2022; 91:72. [PMID: 32882704 PMCID: PMC7492687 DOI: 10.1038/s41390-020-01107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
|
3
|
Sturdy S, Miller F, Hogarth S, Armstrong N, Chakraborty P, Cressman C, Dobrow M, Flitcroft K, Grossman D, Harris R, Hoebee B, Holloway K, Kinsinger L, Krag M, Löblová O, Löwy I, Mackie A, Marshall J, O'Hallahan J, Rabeneck L, Raffle A, Reid L, Shortland G, Steele R, Tarini B, Taylor-Phillips S, Towler B, van der Veen N, Zappa M. Half a Century of Wilson & Jungner: Reflections on the Governance of Population Screening. Wellcome Open Res 2020; 5:158. [PMID: 32923689 PMCID: PMC7468564 DOI: 10.12688/wellcomeopenres.16057.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background: In their landmark report on the "Principles and Practice of Screening for Disease" (1968), Wilson and Jungner noted that the practice of screening is just as important for securing beneficial outcomes and avoiding harms as the formulation of principles. Many jurisdictions have since established various kinds of "screening governance organizations" to provide oversight of screening practice. Yet to date there has been relatively little reflection on the nature and organization of screening governance itself, or on how different governance arrangements affect the way screening is implemented and perceived and the balance of benefits and harms it delivers. Methods: An international expert policy workshop convened by Sturdy, Miller and Hogarth. Results: While effective governance is essential to promote beneficial screening practices and avoid attendant harms, screening governance organizations face enduring challenges. These challenges are social and ethical as much as technical. Evidence-based adjudication of the benefits and harms of population screening must take account of factors that inform the production and interpretation of evidence, including the divergent professional, financial and personal commitments of stakeholders. Similarly, when planning and overseeing organized screening programs, screening governance organizations must persuade or compel multiple stakeholders to work together to a common end. Screening governance organizations in different jurisdictions vary widely in how they are constituted, how they relate to other interested organizations and actors, and what powers and authority they wield. Yet we know little about how these differences affect the way screening is implemented, and with what consequences. Conclusions: Systematic research into how screening governance is organized in different jurisdictions would facilitate policy learning to address enduring challenges. Even without such research, informal exchange and sharing of experiences between screening governance organizations can deliver invaluable insights into the social as well as the technical aspects of governance.
Collapse
Affiliation(s)
- Steve Sturdy
- Science, Technology and Innovation Studies, University of Edinburgh, Edinburgh, EH1 1LZ, UK.,Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, EH8 9LN, UK
| | - Fiona Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | - Stuart Hogarth
- Department of Sociology, University of Cambridge, Cambridge, CB2 1SB, UK
| | | | | | - Celine Cressman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | - Mark Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | | | - David Grossman
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | | | - Barbara Hoebee
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Kelly Holloway
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | | | - Marlene Krag
- Danish Health and Medicines Authority, Kobenhavn, Denmark
| | - Olga Löblová
- Department of Sociology, University of Cambridge, Cambridge, CB2 1SB, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Bernie Towler
- Department of Health and Ageing, Canberra, Australia
| | - Nynke van der Veen
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Marco Zappa
- Instituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| |
Collapse
|
4
|
Sturdy S, Miller F, Hogarth S, Armstrong N, Chakraborty P, Cressman C, Dobrow M, Flitcroft K, Grossman D, Harris R, Hoebee B, Holloway K, Kinsinger L, Krag M, Löblová O, Löwy I, Mackie A, Marshall J, O'Hallahan J, Rabeneck L, Raffle A, Reid L, Shortland G, Steele R, Tarini B, Taylor-Phillips S, Towler B, van der Veen N, Zappa M. Half a Century of Wilson & Jungner: Reflections on the Governance of Population Screening. Wellcome Open Res 2020; 5:158. [DOI: 10.12688/wellcomeopenres.16057.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: In their landmark report on the “Principles and Practice of Screening for Disease” (1968), Wilson and Jungner noted that the practice of screening is just as important for securing beneficial outcomes and avoiding harms as the formulation of principles. Many jurisdictions have since established various kinds of “screening governance organizations” to provide oversight of screening practice. Yet to date there has been relatively little reflection on the nature and organization of screening governance itself, or on how different governance arrangements affect the way screening is implemented and perceived and the balance of benefits and harms it delivers. Methods: An international expert policy workshop convened by the three lead authors. Results: While effective governance is essential to promote beneficial screening practices and avoid attendant harms, screening governance organizations face enduring challenges. These challenges are social and ethical as much as technical. Evidence-based adjudication of the benefits and harms of population screening must take account of factors that inform the production and interpretation of evidence, including the divergent professional, financial and personal commitments of stakeholders. Similarly, when planning and overseeing organized screening programs, screening governance organizations must persuade or compel multiple stakeholders to work together to a common end. Screening governance organizations in different jurisdictions vary widely in how they are constituted, how they relate to other interested organizations and actors, and what powers and authority they wield. Yet we know little about how these differences affect the way screening is implemented, and with what consequences. Conclusions: Systematic research into how screening governance is organized in different jurisdictions would facilitate policy learning to address enduring challenges. Even without such research, informal exchange and sharing of experiences between screening governance organizations can deliver invaluable insights into the social as well as the technical aspects of governance.
Collapse
|
5
|
Rothwell E, Goldenberg A, Johnson E, Riches N, Tarini B, Botkin JR. An Assessment of a Shortened Consent Form for the Storage and Research Use of Residual Newborn Screening Blood Spots. J Empir Res Hum Res Ethics 2017; 12:335-342. [PMID: 29073807 DOI: 10.1177/1556264617736199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
As state newborn screening programs develop approaches to parental permission for the storage and use of residual dried newborn screening samples, it is important to understand how the public comprehends the consent elements. Focus groups in Utah, California, and Michigan ( n = 7 groups, 69 participants) were conducted to evaluate the language on a shortened consent form. Outcomes from the analysis included barriers to conceptualizing biospecimen research, the overly cautious tone and awkwardness of the consent form, and perceptions of community versus individual benefit. This research offers insight on public response to, and comprehension of, commonly used consent language for the storage and use of dried blood spot research in a shortened consent form.
Collapse
Affiliation(s)
| | | | | | | | - Beth Tarini
- 3 The University of Iowa, Iowa City, IA, USA
| | | |
Collapse
|
6
|
Saul RA, Trotter T, Sease K, Tarini B. Survey of family history taking and genetic testing in pediatric practice. J Community Genet 2017; 8:109-115. [PMID: 28064391 DOI: 10.1007/s12687-016-0291-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/26/2016] [Indexed: 12/12/2022] Open
Abstract
Family health history collection and genetic testing are core elements for the successful translation of genomics into primary care practice. Yet, little is known about how pediatric providers implement these elements in practice. We surveyed the membership of the American Academy of Pediatrics regarding family health history (FHH) collection and genetic testing in the primary care setting. Three hundred forty-nine (349) responses were analyzed with the initial response rate of 43.3%. Four principal findings were noted-(1) family health history is still recognized as a critical part of the medical evaluation; (2) perceived obstacles for FHH are time in obtaining the FHH and concerns about the family's knowledge of their FHH; (3) a 3-generation family history is out of the scope of routine care and alternate methods should be considered; (4) most primary care providers (PCPs) do not feel comfortable ordering, interpreting, and counseling regarding current genetic testing. Expanded genetic/genomic education at multiple levels (undergraduate medical education, graduate medical education, and maintenance of certification) is clearly indicated to allow PCPs to integrate these vital elements into a current evaluation (acute care or health maintenance) in the primary care setting.
Collapse
Affiliation(s)
- Robert A Saul
- Center for Pediatric Medicine, Children's Hospital, Greenville Health System, 20 Medical Ridge Drive, Greenville, SC, 29605, USA.
| | | | - Kerry Sease
- Center for Pediatric Medicine, Children's Hospital, Greenville Health System, 20 Medical Ridge Drive, Greenville, SC, 29605, USA
| | - Beth Tarini
- Stead Family Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IL, USA
| |
Collapse
|
7
|
Botkin JR, Lewis MH, Watson MS, Swoboda KJ, Anderson R, Berry SA, Bonhomme N, Brosco JP, Comeau AM, Goldenberg A, Goldman E, Therrell B, Levy-Fisch J, Tarini B, Wilfond B. Parental permission for pilot newborn screening research: guidelines from the NBSTRN. Pediatrics 2014; 133:e410-7. [PMID: 24394680 PMCID: PMC3904278 DOI: 10.1542/peds.2013-2271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/24/2022] Open
Abstract
There is broad recognition of the need for population-based research to assess the safety and efficacy of newborn screening (NBS) for conditions that are not on current panels. However, prospective population-based research poses significant ethical, regulatory, and logistical challenges. In the context of NBS, there have been a variety of approaches that address parental decision-making in pilot studies of new screening tests or conditions. This article presents an ethical and legal analysis of the role of parental permission by the Bioethics and Legal Work Group of the Newborn Screening Translational Research Network created under a contract from the National Institute of Child Health and Human Development to the American College of Medical Genetics and Genomics. Circumstances are outlined in which a waiver of documentation of permission or a waiver of permission may be ethically and legally appropriate in the NBS context. These guidelines do not constitute American Academy of Pediatrics policy.
Collapse
Affiliation(s)
| | | | - Michael S. Watson
- The American College of Medical Genetics and Genomics, Bethesda, Maryland
| | | | | | | | | | | | - Anne M. Comeau
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
This review highlights emerging areas of interest in public health genomics. First, we describe recent advances in newborn screening (NBS), with a focus on the practice and policy implications of current and future efforts to expand NBS programs (e.g., via next-generation sequencing). Next, we detail research findings from the rapidly progressing field of epigenetics and epigenomics, highlighting ways in which our emerging understanding in these areas could guide future intervention and research efforts in public health. We close by considering various ethical, legal, and social issues posed by recent developments in public health genomics; these include policies to regulate access to personal genomic information, the need to enhance genetic literacy in both health professionals and the public, and challenges in ensuring that the benefits (and burdens) of genomic discoveries and applications are equitably distributed. We also note needs for future genomic research that integrates across basic and social sciences.
Collapse
Affiliation(s)
- J Scott Roberts
- Department of Health Behavior & Health Education University of Michigan School of Public Health
| | - Dana Dolinoy
- Department of Environmental Health Sciences University of Michigan School of Public Health
| | - Beth Tarini
- Child Health Evauation & Research Unit Division of Pediatrics University of Michigan Health System
| |
Collapse
|
9
|
Abstract
Children have been identified as uniquely vulnerable clinical research subjects since the early 1970s. This article reviews the historical underpinnings of this designation, the current regulatory framework for pediatric and neonatal research, and common problems in pediatric research oversight. It also presents 3 areas of pediatric and neonatal research (genomic screening, healthy children donating stem cells, and therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy) that highlight contemporary challenges in pediatric research ethics, including balancing risk and benefit, informed consent and assent, and clinical equipoise.
Collapse
Affiliation(s)
- Naomi Laventhal
- Department of Pediatrics and Communicable Diseases, Division of Neonatal-Perinatal Medicine, University of Michigan School of Medicine, 8-621 C&W Mott Hospital, 1540 E. Hospital Drive, SPC 4254, Ann Arbor, MI 48109-4254, Phone: 734-763-4109, Fax: 734-763-7728,
| | - Beth Tarini
- Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Unit, University of Michigan School of Medicine, 300 North Ingalls 6C11, Ann Arbor, Michigan 48109-5456, Phone: 734-615-8153, Fax: 734-264-2599,
| | - John Lantos
- Children’s Mercy Bioethics Center, Children’s Mercy Hospital, 2401 Gilham Rd., Kansas, City, MO 64108, Phone: 816-701-5283, Fax: 816-701-5286,
| |
Collapse
|
10
|
Abstract
Current approaches to genetic screening include newborn screening to identify infants who would benefit from early treatment, reproductive genetic screening to assist reproductive decision making, and family history assessment to identify individuals who would benefit from additional prevention measures. Although the traditional goal of screening is to identify early disease or risk in order to implement preventive therapy, genetic screening has always included an atypical element-information relevant to reproductive decisions. New technologies offer increasingly comprehensive identification of genetic conditions and susceptibilities. Tests based on these technologies are generating a different approach to screening that seeks to inform individuals about all of their genetic traits and susceptibilities for purposes that incorporate rapid diagnosis, family planning, and expediting of research, as well as the traditional screening goal of improving prevention. Use of these tests in population screening will increase the challenges already encountered in genetic screening programs, including false-positive and ambiguous test results, overdiagnosis, and incidental findings. Whether this approach is desirable requires further empiric research, but it also requires careful deliberation on the part of all concerned, including genomic researchers, clinicians, public health officials, health care payers, and especially those who will be the recipients of this novel screening approach.
Collapse
Affiliation(s)
- Wylie Burke
- Department of Bioethics and Humanities, A204 Health Sciences Building, Box 357120, University of Washington, Seattle, WA 98195, USA.
| | | | | | | |
Collapse
|
11
|
Affiliation(s)
- Beth Tarini
- University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|